billing the dmercs and others for infusion pumps - ION Solutions

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A WORD ABOUT PRIVATE PAYERS(May Be Easier; May Be Harder)
IMPORTANT TO KNOW ABOUT BENEFITS… Does the patient have a benefit for DME or HomeHealth Care? Can be covered under either orboth for private payers… Does the payer need a referral, priorauthorization, and/or a CMN? Is the drug you are using covered under thepayers policy for home infusion? Do they have a preferred vendor and you are notit?
Page 1: BILLING THE DMERCS ANDOTHERS FOR IN
Page 4 and 5: BUZZWORDSDIF-DME Information FormDM
Page 6 and 7: WHAT IS REIMBURSABLE DME? Payment m
Page 8 and 9: HOW IS DME CLASSIFIED? IN=Inexpensi
Page 10 and 11: PORTABLE PUMP: RENTAL PROVISIONS Ca
Page 12 and 13: OLD PUMP CMN—CMS FORM 851
Page 15 and 16: SNF CONSOLIDATED BILLING The Social
Page 17 and 18: MAIN DME CONTRACTORS Durable Medica
Page 19 and 20: DME MAC Types of Claims DME Prosthe
Page 21 and 22: NSC Contact Infohttp://www.palmetto
Page 23 and 24: CEDI Single front-end electronic so
Page 25 and 26: DME MAC COVERED DRUGS Epoetin alfa
Page 27 and 28: OTHER MODIFIERS JB: Administered su
Page 32 and 33: DIF DOCUMENTATIONSection 1833(e) of
Page 34 and 35: COVERAGE CONDITIONS FOR EXTERNALPUM
Page 42 and 43: HCPCS HCPCS Modifiers EY - No physi
Page 44 and 45: DMERC FEE SCHEDULECode Description
Page 46 and 47: 96416—INITIATION OF PROLONGEDINFU
Page 48 and 49: 96521-REFILLING AND MAINTENANCE OF
Page 52 and 53: OTHER THINGS ABOUT PRIVATE PAYERS W
Page 54 and 55: COMPLIANCE ISSUES Billing for items
Page 56 and 57: RESPONDING TO REQUESTS (CIGNA)Below
Page 58 and 59: CONCLUSIONS DME billing is complex,
Page 60: DME RESOURCES Durable Medical Equip

billing the dmercs and others for infusion pumps - ION Solutions

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